erb's palcy

                           ERB'S  PARALYSIS  

 BRACHIAL   PLEXUS :-

"  The  brachial   plexus   is  a  network   of   nerves  constituted  by   the  anterior  primary   rami of   spinal nerves  C5,C6 ,C7 ,C8  And  T1 with  contributions  from  the  anterior  primary  rami  of  C4 and  T2 ."

ERB'S  PARALYSIS  :-

• It  is  form  of  obstetric   paralysis.
• The  region  of  upper   trunk   of  brachial  plexus is  called  erb's  point.   Six  nerves  meet  here .Paralysis or injury   of  this  point  is  called  erb's  paralysis .

EPIDEMIOLOGY :- 0.8- 1 Per 1000  birth  in  United  State. 

ETIOLOGY :-

• Undue  separation  of  the  head  from  shoulder , which is  common  in  following :-

1. Birth  injury  .
2. Excessive  traction   on  shoulder. 
3. Fracture  of  clavicle  during   vaginal  delivery .
4. Forcep's  delivery. 
   

RISK  FACTORS :-

• Maternall  obesity  .
• Gestational   diabetes. 
• During  second  stage  of  labor.

DEFORMITY   ANDI  ATTITUDE   OF   LIMB:- 

• Arm  hangs  by  side  in adducted and  medially   rotated  position .
• Forearm  extended  and  pronoted. 
• Wrist  flexed. 
• Hand and  fInger  functions  are  usually  preserved  or  slightly  affected.

THE   DEFORMITY  IS  KNOWN  AS  POLICEMSN'S  TIP  HAND   OR  WAITER'S  TIP  HAND  or  PORTER'S    HAND .

ĎISABILITY:- 

The  following  movements  are  lost:-

• Abduction  and  lateral  rotation  of  Arm  and  shoulder  joint   .
• Flexion  and  supination   of  forearm  .
• Extension   of  wrist.
• Biceps  and  supination  jerks  are  lost.
• Sensation  are lost  over  a small  area  over  the  lower  part  of deltoid.

DIAGNOSIS  :- 

• X- Ray  chest  for  clavicle  and  humerus   fracture.
• MRI   for   shoulder  dislocation. 
• CT  scan.
• Electromyography.

PHYSICAL   EXAMINATION :-

• History taking  for  any  pregnancy   related complications.
• Examination   of  PROM.
• Examination  of  reflex  usually  Moro's  reflex  absent.
• Examination  of  sensitivity  .
• Examination  of  vascular  status.
• Mannual muscle   testing .

TREATMENT :- 

MEDICAL  TREATMENT :- 

• In  maximum   case no  medical  treatment  is   required. 
• Maximum  cases recovers  from physiotherapy. 
• In some  cases  bortex  therapy  may  use.

In  some  cases  surgical intervention   require.

Which may  be  nerve  graft  repair  and  nerve   decompression   surgery etc.

PHYSIOTHERAPY  MANAGEMENT :-

• GOALS:-  
• Prevent   development  of  deformity  .
•  Prevent development  of   contractures.
• Improve  muscle  strength. 

Maintain  join  range  of  motion. 

TREATMENT :-

• POSITIONING  OF  AFFECTED  ARM:-

• SHOULDER :- Abduction  and  external  rotation. 
• ELBOW :- Flexed  position. 
• FOREARM :- Supinated. 
• WRIST  :-Behind  the  head.
  
• This   position  prevents   contracture  of  subscapularis   , pectoral is  major  and  other.
• Sensory   stimulation.
• Motor  stimulation  via  electrical  modialities  like EMS.
• Passive  joint  range of motion exercises.